Breast Cancer: Reconstruction / Prosthesis

Reconstruction of the breast is an option for most women who have had a mastectomy. You may choose immediate reconstruction, in which the process is started during the same surgery as the mastectomy. Or you may delay reconstruction and start the procedures after your initial surgery and other treatments are complete. Some women say that starting reconstruction right away helps reduce the trauma of losing a breast; immediate reconstruction also eliminates the need for an additional hospitalization and anesthesia.

There are two methods for reconstruction: using an implant to replace the lost tissue or using tissues from elsewhere in the body to replace the lost tissue. The new breast will not function like a breast, and it will not have much sensation. But depending on the method of reconstruction, in clothes it can look almost exactly like the other breast. In the final step, a new nipple-areola complex is built and the nipple area can be tattooed to have a similar color to the other.

Radiation therapy can sometimes cause damage to the skin that makes breast reconstruction challenging. Our plastic surgeons have extensive experience with reconstruction for patients who have already had radiation therapy.

As of October 1998, a federal law requires insurance companies to cover all aspects of reconstruction, including operations to match the reconstructed breast to the opposite breast.

Implant Surgery

Implants are best for women with small- to medium-size breasts and those who have not had any radiation therapy to the breast area. In the first step, a pocket is formed from the pectoralis muscle and an expander is placed in that space. Over the next several months, saline is injected through a valve into the expander sac to slowly stretch the skin and muscle in preparation for the permanent implant. During a second, shorter operation, the expander is removed and the implant is inserted in its place.

Implants come in different shapes and sizes and are made of saline or silicone. A plastic surgeon will help determine which type of implant is best for you.

Tissue Transfer

Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle from one of three locations:

TRAM (transverse rectus abdominus myocutaneous) Flap

An oval-shaped section of fat and skin is removed from the abdomen and shaped into a breast on the chest wall.

Gluteal Free Flap

Tissue is taken from the upper or lower buttocks and shaped into a breast on the chest wall.

Latissimus Dorsi Flap

Skin and muscle are moved from the upper back to the chest area and shaped into a breast.

The type of reconstruction that is most appropriate for each patient depends on the amount of skin remaining on the chest wall, the size and shape of the other breast, the amount of body fat and tissue available elsewhere, the patient's general health, her smoking history, and her personal preferences. If you know that you will want a reconstruction, you should talk to your doctor about it early in your treatment — even before you have a surgical biopsy, if possible. Your choice might influence where incisions are made.

Once the breast mound is completed, the other breast may be altered (with an implant, a reduction, or a lift) to achieve symmetry. In the final step, a new nipple-areola complex is built, and the area can then be tattooed to have a similar color to the other side.

Prosthesis

Women who decline or cannot undergo breast reconstruction can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast. Prostheses can be placed in a special pocket in a bra or bathing suit. A properly fitted and weighted prosthesis provides the balance needed for correct posture. Custom-made prostheses are now also available.

To purchase a prosthesis, visit the boutique in the Evelyn H. Lauder Breast Center, ask your doctor or nurse for referrals to stores (some hospitals have their own stores on-site), or call the local office of the American Cancer Society. These stores specialize in breast prostheses and post-mastectomy bras and have experienced, sensitive, certified fitters who will help you find the perfect prosthesis for your body. The fitter will consider the type of surgery you had as well as the size, shape, and texture of your remaining breast to select the prosthesis that is best for you. Fitters also provide instructions for care of the prosthesis.

Before purchasing a breast prosthesis, make sure that you have a prescription from your doctor. Both prostheses and post-mastectomy bras are often covered by insurance.